Thyrotoxicosis (adjunct)
▶BY MOUTH
▶Neonate:Initially 250 – 500 micrograms/kg every
6 – 8 hours, adjusted according to response.
▶Child:Initially 250 – 500 micrograms/kg every 8 hours,
adjusted according to response; increased if necessary
up to 1 mg/kg every 8 hours (max. per dose 40 mg every
8 hours)
▶BY INTRAVENOUS INJECTION
▶Neonate:Initially 20 – 50 micrograms/kg every 6 – 8 hours,
adjusted according to response, to be given over
10 minutes.
▶Child:Initially 25 – 50 micrograms/kg every 6 – 8 hours
(max. per dose 5 mg), adjusted according to response,
to be given over 10 minutes
Thyrotoxic crisis
▶BY MOUTH
▶Neonate:Initially 250 – 500 micrograms/kg every
6 – 8 hours, adjusted according to response.
▶Child:Initially 250 – 500 micrograms/kg every 8 hours,
adjusted according to response; increased if necessary
up to 1 mg/kg every 8 hours (max. per dose 40 mg every
8 hours)
▶BY INTRAVENOUS INJECTION
▶Neonate:Initially 20 – 50 micrograms/kg every 6 – 8 hours,
adjusted according to response, to be given over
10 minutes.
▶Child:Initially 25 – 50 micrograms/kg every 6 – 8 hours
(max. per dose 5 mg), adjusted according to response,
to be given over 10 minutes
Hypertension
▶BY MOUTH
▶Neonate:Initially 250 micrograms/kg 3 times a day, then
increased if necessary up to 2 mg/kg 3 times a day.
▶Child 1 month–11 years:Initially 0. 25 – 1 mg/kg 3 times a
day, then increased to 5 mg/kg daily in divided doses,
dose should be increased at weekly intervals
▶Child 12–17 years:Initially 80 mg twice daily, then
increased if necessary up to 160 – 320 mg daily, dose
should be increased at weekly intervals, slow-release
preparations may be used for once daily administration
Migraine prophylaxis
▶BY MOUTH
▶Child 2–11 years:Initially 200 – 500 micrograms/kg twice
daily; usual dose 10 – 20 mg twice daily (max. per dose
2 mg/kg twice daily)
▶Child 12–17 years:Initially 20 – 40 mg twice daily; usual
dose 40 – 80 mg twice daily (max. per dose 120 mg);
maximum 4 mg/kg per day
Arrhythmias
▶BY MOUTH
▶Neonate: 250 – 500 micrograms/kg 3 times a day, adjusted
according to response.
▶Child: 250 – 500 micrograms/kg 3 – 4 times a day (max.
per dose 1 mg/kg 4 times a day), adjusted according to
response; maximum 160 mg per day
▶BY SLOW INTRAVENOUS INJECTION
▶Neonate: 20 – 50 micrograms/kg, then
20 – 50 micrograms/kg every 6 – 8 hours if required, eCG
monitoring required.
▶Child: 25 – 50 micrograms/kg, then
25 – 50 micrograms/kg every 6 – 8 hours if required, eCG
monitoring required
Tetralogy of Fallot
▶BY MOUTH
▶Neonate: 0. 25 – 1 mg/kg 2 – 3 times a day (max. per dose
2 mg/kg 3 times a day).▶Child 1 month–11 years: 0. 25 – 1 mg/kg 3 – 4 times a day,
maximum dose to be given in divided doses; maximum
5 mg/kg per day
▶BY SLOW INTRAVENOUS INJECTION
▶Neonate:Initially 15 – 20 micrograms/kg (max. per dose
100 micrograms/kg), then 15 – 20 micrograms/kg every
12 hours if required, eCG monitoring is required with
administration.▶Child 1 month–11 years:Initially 15 – 20 micrograms/kg
(max. per dose 100 micrograms/kg), higher doses are
rarely necessary, then 15 – 20 micrograms/kg every
6 – 8 hours if required, eCG monitoring is required with
administrationlUNLICENSED USENot licensed for treatment of
hypertension in children under 12 years.IMPORTANT SAFETY INFORMATION
SAFE PRACTICE
Propranolol has been confused with prednisolone; care
must be taken to ensure the correct drug is prescribed
and dispensed.lINTERACTIONS→Appendix 1 : beta blockers, non-selective
lSIDE-EFFECTS
▶Rare or very rareMemory loss.mood altered.
neuromuscular dysfunction.psychosis
lHEPATIC IMPAIRMENT
Dose adjustmentsReduce oral dose.
lRENAL IMPAIRMENT
Dose adjustmentsManufacturer advises caution; dose
reduction may be required.
lDIRECTIONS FOR ADMINISTRATIONForslow intravenous
injection, give over at least 3 – 5 minutes; rate of
administration should not exceed 1 mg/minute. May be
diluted with Sodium Chloride 0. 9 % or Glucose 5 %.
Incompatible with bicarbonate.
lPRESCRIBING AND DISPENSING INFORMATIONModified-
release preparations can be used for once daily
administration.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension, oral solution
Oral solution
CAUTIONARY AND ADVISORY LABELS 8
▶Propranolol hydrochloride (Non-proprietary)
Propranolol hydrochloride 1 mg per 1 mlPropranolol 5 mg/ 5 ml
oral solution sugar free sugar-free| 150 mlP£ 21. 67 DT = £ 21. 59
Propranolol hydrochloride 2 mg per 1 mlPropranolol 10 mg/ 5 ml
oral solution sugar free sugar-free| 150 mlP£ 26. 66 DT = £ 26. 56
Propranolol hydrochloride 8 mg per 1 mlPropranolol 40 mg/ 5 ml
oral solution sugar free sugar-free| 150 mlP£ 34. 77 DT = £ 34. 64
Propranolol hydrochloride 10 mg per 1 mlPropranolol 50 mg/ 5 ml
oral solution sugar free sugar-free| 150 mlP£ 35. 26 DT = £ 35. 12
Modified-release capsule
CAUTIONARY AND ADVISORY LABELS8, 25
▶Propranolol hydrochloride (Non-proprietary)
Propranolol hydrochloride 80 mgPropranolol 80 mg modified-
release capsules| 28 capsuleP£ 4. 95 DT = £ 4. 95
Propranolol hydrochloride 160 mgPropranolol 160 mg modified-
release capsules| 28 capsuleP£ 4. 88 DT = £ 4. 88
▶Bedranol SR(Sandoz Ltd, Almus Pharmaceuticals Ltd)
Propranolol hydrochloride 80 mgBedranol SR 80 mg capsules|
28 capsuleP£ 4. 16 DT = £ 4. 95
Propranolol hydrochloride 160 mgBedranol SR 160 mg capsules|
28 capsuleP£ 4. 59 – £ 5. 09 DT = £ 4. 88BNFC 2018 – 2019 Hypertension 105
Cardiovascular system2